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Abstract
Background Our specialist community palliative care service is a multidisciplinary service providing 24-hour care in the greater Newcastle area of New South Wales. With COVID-19 pandemic impacting our service, a triage tool become necessary to guide resource allocation. RUN-PC Triage Tool was identified as a validated triage tool during our scoping exercise. Therefore, an implementation pilot was conducted to evaluate the RUN-PC Triage Tool in our community palliative care setting.1
Objective To identify whether initial assessment occurring within the RUN-PC Triage Tool recommended timeframes impacts clinical deterioration risk, and to explore relationships between RUN-PC Triage Tool component scores and clinical deterioration.
Methods A retrospective observational study of community palliative care referrals from May 2021 to November 2021 at Calvary Mater Newcastle Community Palliative Care Service. Data were extracted from the electronic medical records and patients were dichotomised into two groups for analysis based on whether the initial assessment occurred within or outside the RUN-PC recommended response time (Group 1 and Group 2 respectively). Clinical deterioration was defined using five Palliative Care Outcomes Collaboration (PCOC) assessment tools as – a) an increase of score ≥ 1 in SAS, PSS and RUG-ADL; b) a decrease of score of ≥ 10 in AKPS; c) an adverse change of phase; or d) an emergency department presentation prior to initial assessment. The relationship between RUN-PC Triage Tool component scores and overall deterioration was explored visually.
Results A total of 337 referrals were reviewed, and 161 were excluded, primarily due to having no initial assessment (n = 83). At baseline, Group 2 patients had significantly higher RUN-PC, PSS and SAS difficulty sleeping scores and were younger. There were also no patients in terminal phase at triage in both groups. Among the 176 patients included, there were no statistically significant differences in the overall clinical deterioration between the two groups using Fisher’s exact test (p = 0.132), with 89.1% in Group 1 and 80% in Group 2 experiencing deterioration (table 1). Among the 101 patients in Group 1, the proportion of overall clinical deterioration increased as the RUN-PC score increased in all individual RUN-PC Triage Tool components and in total RUN-PC scores, but this was not statistically examined (figure 1).
Discussion Although our findings suggest that implementation of this triage tool did not impact the deterioration outcome used in this study, the predictive value of RUN-PC components was observed. As a tertiary specialist palliative care service, it is likely that referrals were occasionally responded to without formal triage assessment and interventions were often implemented at triage for patients with acute distress. Our research during the COVID-19 pandemic provides further support for the implementation of clinical screening tools within a wider quality improvement framework. Further research could consider outcomes beyond deterioration and patients‘ and carers’ experiences.
Reference
Russell B, Philip J, Wawryk O, Vogrin S, Burchell J, Collins A, et al. Validation of the responding to urgency of need in palliative care (RUN-PC) triage tool. Palliative Medicine 2021;35(4):759–67.
ReferenceTable 1 shows the overall deterioration between triage and initial assessment time points in Group 1 (seen within the recommended time) and Group 2 (seen outside the recommended time).
Overall deterioration of group 1 and group 2
Figure 1 illustrates a positive trend towards higher baseline RUN-PC scores falling into increasing symptom severity categories.
Proportion of patients with overall deterioration in each RUN-PC component and total score category. (n = 90)